REP42116

• Permit No: M1978168
• IBM Index Class Name: Report
• Doc Date: 10/17/2002
• Doc Name: 2002 Annual Report
• From: Delta County
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME: Delta County RECEI VEC
PERMIT NO.: M-1978-168 OCT ~ j 2~~2
OPERATION NAME:
ANNIVERSARY DATE: Pig Mesa Pit
October 26, 2002 Division of Minerals and Geology
ANNUAL FEE DUE: $685.00 (Due on or before your anniversary date)
COUNTY: Delta
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an
_ _-__operator_shall_submit_the-annual fee, areport-and-map showing the-extent-of-current-disturbances to affected ----
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annual report and annual report map to this form. Please note that art
adequately Labeled map that clearly delineates and includes the above elements may suffice for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact
Permittee Name:
Address:
Phone Number:
Fax Number:
LArry Record
Delta County
501 Palmer St., Ste. 227
Delta, CO 81416
[phone]
[phone] -__`
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to [his form along with your written report and map. Annual Report instructions are
enclosed.
ature of C rporate Off' er, Owner, or Designee
Date
M:~PERM ITUTASTERDOCDMENTSN1-AF-04